The Gentle Touch in Crisis Care
- 4 days ago
- 5 min read
Updated: 1 day ago
Written by Clifford Cartagena, CEO & Founder
Clifford Cartagena, RN, BSN, is a psychiatric nurse, safety trainer, and founder of Gentleway Systems LLC. Co-founder of Arizona Care Horizon Institute, he is completing his Psychiatric-Mental Health Nurse Practitioner (PMHNP) degree at Walden University. Author of The Gentle Art of Crisis, he advances trauma-informed, dignified approaches to workplace safety.
For more than two decades as a nurse, I have worked in environments where human emotions can reach their most challenging moments, psychiatric hospitals, emergency departments, correctional healthcare facilities, state hospitals, detox programs, dementia care settings, and medical units.
I have witnessed fear, confusion, and aggression. I have also witnessed dedicated healthcare professionals placing themselves in difficult situations every day to protect others.
Throughout those years, one question continued to shape my perspective: when a person loses control, how do we maintain safety without losing compassion?
Because in healthcare, success should never be measured only by whether we stopped a behavior. It should also be measured by how we protect the person behind that behavior.
The moment when words are not enough
Every healthcare professional hopes that prevention works. We hope communication works, and we hope that listening, understanding, and therapeutic approaches help someone regain control before a crisis occurs. Many times, they do. But healthcare professionals also understand reality.
There are moments when a person may become an immediate danger to themselves or others. A patient may be experiencing severe psychosis, overwhelming fear, confusion from dementia, the effects of substances, withdrawal symptoms, or an emotional state where reasoning is temporarily unavailable.
In these moments, intervention may become necessary. The important question becomes, how do we intervene?
The person behind the crisis
One of the greatest lessons I learned throughout my nursing career is that the same behavior can have very different meanings.
A person living with dementia who pushes away a caregiver may not understand they are receiving help. In their reality, they may believe they are protecting themselves.
A patient experiencing hallucinations may be responding to something they truly perceive as threatening. A person struggling with substance withdrawal may be overwhelmed by physical discomfort and emotional distress.
A person in a correctional environment may challenge limits or test boundaries. The outward behavior may look similar, but the reason behind the behavior can be very different. When we understand the reason, we change the response.
When helping hands become remembered hands
Healthcare professionals often remember whether a crisis ended safely. Patients may remember something different. They may remember how we approached them, how we spoke to them, how we touched them, and how they felt.
For someone already experiencing fear, trauma, confusion, or loss of control, a physical intervention can become another painful experience. It can also become a moment where they feel protected during their worst day. The difference is often the approach.
Protecting the most vulnerable
Working with older adults and individuals living with dementia has greatly influenced the way I view physical intervention. Many of these individuals are medically fragile. Their skin may tear easily, their bones may be weaker, and their balance may already be impaired.
A method that may physically control a younger, stronger individual may create unnecessary harm for someone medically vulnerable.
This is why crisis response cannot simply ask, “Did we control the behavior?” We must also ask, “Did we protect the whole person?” Their body, their dignity, and their emotional well-being must all be protected.
Strength is not always the answer
My years in both healthcare and martial arts taught me an important principle: true skill is not demonstrated by using the greatest amount of force.
True skill is knowing how little force is actually needed. In crisis care, more force does not automatically mean more safety. Sometimes it creates more resistance.
A calm voice, controlled movement, teamwork, and understanding human behavior can often accomplish what force cannot. The goal should never be to overpower another human being. The goal should be to help restore safety.
The emotional impact on healthcare workers
Protecting dignity does not mean ignoring staff safety. I have seen the impact of workplace violence on healthcare professionals. I have seen compassionate nurses and caregivers injured. I have seen dedicated staff become fearful, frustrated, and emotionally exhausted.
Healthcare workers deserve to go home safely. Patients deserve compassionate care. These goals are not opposite sides of the conversation. They depend on each other.
A system that protects only patients while ignoring staff will fail. A system that protects only staff while forgetting humanity will also fail. The future must protect both.
What happens after the crisis matters
One of the most overlooked moments in crisis care happens after the situation ends. The patient is calm, the environment is safe, and everyone moves forward. But do we truly learn?
After every crisis, we should ask what the unmet need was, what warning signs we saw, and whether anything could have been prevented. We should also ask how the patient is recovering and how the staff is recovering. A strong safety culture does not simply document incidents. It grows from them.
The future of crisis intervention
The future of healthcare safety cannot only focus on faster responses or stronger interventions. It must focus on prevention, understanding, and the preservation of humanity.
There will always be moments when intervention is necessary. But even during those moments, we can choose how we show up.
We can show up with frustration or with professionalism. We can show up with force alone or with skill and compassion. Because the person experiencing the worst moment of their life is still a person.
Final reflection
A patient may forget the hospital’s name. They may forget the policy, and they may forget the procedure. But they may remember how they felt when they were most vulnerable. Did they feel controlled, or did they feel protected?
That difference matters. The future of crisis care depends on our ability to protect safety while never forgetting dignity.
Read more from Clifford Cartagena
Clifford Cartagena, CEO & Founder
Clifford Cartagena, RN, BSN, is a psychiatric and medical-surgical nurse, hospice provider, safety trainer, and founder of Gentleway Systems LLC. He is also the co-founder of the Arizona Care Horizon Institute. He was authorized by the ADHS (Arizona Department of Health Services) to deliver the Memory Care Services Training in Arizona. Cliff is currently completing his Psychiatric Mental Health Nurse Practitioner (PMHNP) degree at Walden University. He is the author of The Gentle Art of Crisis. With more than 20 years of nursing and leadership experience, he developed the Gentleway System, a trauma-informed approach to preventing and managing assaultive behaviors across healthcare and beyond.
References:
Substance Abuse and Mental Health Services Administration. (2023). Practical guide for implementing a trauma-informed approach. U.S. Department of Health and Human Services.
National Institute for Occupational Safety and Health. (2021). Workplace violence prevention strategies and research needs. Centers for Disease Control and Prevention.
The Joint Commission. (2021). Workplace violence prevention standards.
